Provider Demographics
NPI:1578282448
Name:ALLENTUCK, JAMES ABRAHAM (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ABRAHAM
Last Name:ALLENTUCK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E 2ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2333
Mailing Address - Country:US
Mailing Address - Phone:413-854-7717
Mailing Address - Fax:
Practice Address - Street 1:817 E 2ND ST APT 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2333
Practice Address - Country:US
Practice Address - Phone:413-854-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2334776363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care